Provider Demographics
NPI:1457810558
Name:BROWN, BIANCA DANIELLE
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:DANIELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17872
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78760-7872
Mailing Address - Country:US
Mailing Address - Phone:512-775-0251
Mailing Address - Fax:
Practice Address - Street 1:810 E SLAUGHTER LN APT 11204
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-2139
Practice Address - Country:US
Practice Address - Phone:512-775-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX346620164X00000X
320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No164X00000XNursing Service ProvidersLicensed Vocational Nurse